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Burnett County Subdivision Permit Application Fces(must accompany form): <br /> and/or Pre-Application Form Subdivision w/o Survev: $10.00 <br /> /AP Subdivision w/Survey:$100.00+$15.(10/lot <br /> Owner: Q�' (w I I zaNf q ^ <br /> Address: 6 / / 7 I- 'w-, Ilj L&-f�-t W <br /> f' I � <br /> gr' p� Phone: u / /-�(' '7101 3 <br /> (�UP.b er 1�l 1 z <br /> 020-y327 r ,} <br /> 02gd0- 0 3000 - 63010 Original Parcel Information J <br /> o3zont -- ti 3300 'I / <br /> Parcel Identification#: dw -7327-6-51Q() Section Z�7 Township—�6 aoge �� W <br /> Original Description(or attach copy): 5 W VLI 'Al i.Aj //q C <br /> f <br /> 0 <br /> A <br /> v <br /> Current Zoning: Z rb Floodplain NOWetlands Y{l� <br /> Lake/River Classification: Name of Water Body: ---- - <br /> New Parcel Information £ <br /> / <br /> Proposed New Legal Description and Parcel Size: (ji—th 7 off r C S /h <br /> a o <br /> t <br /> E <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. Seea�ttached for preliminary�map requirements.) � <br /> Proposed access to public road: ClJ U�A IIDQ A e - ,( ((1, <br /> i <br /> qv <br /> Signature of Applicant: Ala'4- Z -1. K2aEttA 2 Date• 0 ' 9'06 <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> 0 <br /> ➢ Does parcel require a Survey? c� No <br /> A <br /> ➢ Permit application fees submitted? ❑ Amount$ Receipt# D <br /> e <br /> es <br /> ❑Reconciles with Real Property Lister Yes No Date: <br /> op <br /> If not,explain: P <br /> W W <br /> w J jjN <br /> I <br /> dWooW � <br /> W Do 0 0 <br /> Application Approve / Denied Reason for Denial: o o Q o <br /> Land Use: Date: �' �� <br />